Öz
Tüberküloz (TB), küresel çabalara rağmen yüksek morbidite ve mortalite oranlarıyla günümüzün halk sağlığı sorunlarından biri olmaya devam ediyor. Hem gelişmekte olan hem de gelişmiş ülkelerde, sağlık çalışanları ve öğrenciler maruziyet ve enfeksiyon için önemli bir risk grubunu temsil etmektedir. TB enfeksiyon kontrolünün önemli bileşenlerinden biri, sağlık çalışanlarının gizli tüberküloz enfeksiyonu için rutin olarak taranması ve testi pozitif olanlara kemoprofilaksi uygulanmasıdır. Bu çalışmanın amacı, gelecekte sağlık hizmeti sektöründe aktif olarak görev alacak olan sağlıklı, sağlık teknikeri öğrencileri arasında saflaştırılmış protein türevi (PPD) reaksiyonlarının dağılımını analiz etmek ve skar varlığı, skar sayısı ve PPD reaktivitesi arasındaki korelasyonu belirlemektir. 2017-2020 yılları arasında Sağlık Hizmetleri Meslek Yüksekokulunda öğrenim gören öğrencilerin demografik özellikleri ve PPD deri testi sonuçları ve önceki Bacillus Calmette-Guèrin (BCG) skar sayısı retrospektif olarak değerlendirilmiştir. İstatistiksel değerlendirmeler SPSS V.22 programı kullanılarak yapılmıştır. Bağımsız değişkenler sayı ve yüzde ile gösterilmiştir. Bağımlı değişkenlere ise, ki-kare testi uygulanmıştır. Çalışmaya toplam 390 öğrenci dahil edilmiştir. Öğrencilerin %13,1’i PPD pozitif olarak bulunmuştur. PPD pozitiflik oranları, %10,0 (15-20 mm) ve %3,1 (20 ve üzeri mm) olarak tespit edilmiştir. Öğrencilerin skar sayıları sıfırdan ikiye kadar değişmiştir. BCG skar sayıları ve PPD endürasyon çapları arasındaki ilişki istatistiksel olarak anlamlı bulunmuştur (p<0,05). BCG skarı olmayanların öğrencilerin tamamı PPD negatiftir. Sağlık teknikeri adayları arasında PPD negatifliği ve BCG pozitifliğinin yüksek oranı aşı kaynaklı koruyucu bağışıklığın bir göstergesidir.
Anahtar Kelimeler
Destekleyen Kurum
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Proje Numarası
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Teşekkür
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Kaynakça
- 1.World Health Organization.Global tuberculosis report 2019.Geneva:WHO;2019.https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1
- 2.Sağlık Bakanlığı Tüberküloz Tanı ve Tedavi Rehberi, 2. Baskı Ankara, Mayıs 2019 ISBN: 978-975-590-717-8.
- 3.Şi̇mşek A,Özkan S.(2019). Ankara İlinde Yapılan Aktif Sürveyans Uygulamasının Tüberküloz Hastalarının Kayıt ve Takibine Katkısının Değerlendirilmesi. Ankara Medical Journal, 19 ,71-82.
- 4. Xu Y, Schwartzman K.(2010). Referrals for Positive Tuberculin Tests in New Health care Workers and Sudents: A retrospective Cohort Study. BMC Public Health. 2010;10:28. Published 2010 Jan 20.
- 5.Centers for Disease Control and Prevention (CDC) .Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 2005, Morbidity and Mortality Weekly Report (MMWR) 54(RR17);1-141, (December 30, 2005).
- 6.Occupational Safety & Health Administration (OSHA). Occupational Exposure to Tuberculosis 1910.1035; Proposed Rule. OSHA Federal Register Final Rules 62:54159-54309, (1997, October 17). https://www.osha.gov/SLTC/etools/hospital/references.html
- 7.Bo M ,Zotti CM.(2016). European Policies on Tuberculosis Prevention in Healthcare Workers: Which Role for BCG? A Systematic Review.Human Vaccines & Immunotherapeutics, 12(11), 2753-2764.
- 8.Kinikar A, Chandanwale A, Kadam D, Joshi S, Basavaraj A.et al.(2019).High Risk for Latent Tuberculosis Infection Among Medical Residents and Nursing Students in India. PLOS ONE 14(7): e0219131.
- 9.Uden L, Barber E,Ford N, Cooke G S.(2017). Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis, Open Forum Infectious Diseases,4,(3),1-7.
- 10.Peters C, Kozak A, Nienhaus A, Schablon A.(2020). Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health,17(2):581,2-16. 11.Özkara Ş.(2000).Sağlık Çalışanları ve Tüberküloz. Flora,5(2),90-98.
- 12.Nayak S,Acharjya B.(2012). Mantoux Test and Its Interpretation. Indian Journal of Dermatology,3(1):2-6.
- 13.Pahal P, Sharma S.(2020). PPD Skin Test (Tuberculosis Skin Test) .In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
- 14.Hotta K, Ogura T, Nishii K, et al.(2007). Whole blood interferon-gamma assay for baseline tuberculosis screening among Japanese healthcare students. PLoS One,2(8),e803.
- 15.Xu Y, Schwartzman K.(2010). Referrals for Positive Tuberculin Tests in New Health care Workers and Students: A Retrospective Cohort Study. BMC Public Health,10(28),2-7.
- 16. Fjällbrant H. BCG Vaccination and the Tuberculin Skin Test in a Country with Low Prevalence of Tuberculosis: Epidemiological and Immunological Studies in Healthy Subjects. Sahlgrenska Academy University of Gothenburg Sweden 2008.
- 17.Ghaderi R .(2017). A New Formula for BCG Scar and Tuberculin Test Response,MOJ Immunol 5(5): 00171.
- 18. Bozkanat E, et al. (2016).Comparison of Tuberculin Skin Test and quantiferon-TB Gold in Tube Test for Diagnosis of Latent Tuberculosis Infection in Health care Workers: A Cross Sectional Study. Journal Of Pakistan Medical Association,66(3): 270-4.
- 19. Hizel K, Maral I, Karakuş R, Aktaş F.(2004). The influence of BCG immunisation on tuberculin Reactivity and Booster Effect in Adults in a Country with a High Prevalence of Tuberculosis. Clinical Microbiology and Infection, 10: 980-983.
- 20. İmre A, Arslan-Gülen T, Koçak M, Baş-Şarahman E, Kayabaş Ü.(2020). Sağlık Hizmeti Sunan Hastane Çalışanlarıyla Risk Grubunda Olmayan Sağlıklı Bireylerin Tüberkülin Deri Testi Sonuçlarının İrdelenmesi Klimik Dergisi,33(1),19-23.
- 21. Casas I, Esteve M, Guerola R, Latorre I, Villar-Hernández R, Mena G, et al. (2020) Serial testing of health care workers for tuberculosis infection: A prospective cohort study. PLoS ONE ,15(7), e0235986.
- 22. Uden L, Barber ., Ford N,Cooke G S. (2017). Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infectious Diseases, 4(3), 1–7.
- 23. Salehi M, Sharifi Mood B, Metanat M.(2016). Positive Tuberculin Skin Test Among Health Care Workers: Prevalence and Risk Factors in Teaching Hospitals of a Highly Endemic Region for Tuberculosis, Zahedan, Iran, Int J Infect. 2016 ; 3(3):e36158.
- 24. Chen B et al.(2019). Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities. International Journal of Infectious Diseases,79:26-33.
- 25. World Health Organization Informatıon sheet observed rate of vaccıne reactıons bacılle calmette-guérın (bcg) vaccıne.Geneva:WHO;2012 https://www.who.int/vaccine_safety/initiative/tools/BCG_Vaccine_rates_information_sheet.pdf?ua=1
- 26. Dhanawade SS, Kumbhar SG, Gore AD, Patil VN.(2015). Scar Formation and Tuberculin Conversion Following BCG Vaccination in Infants: A Prospective Cohort Study. Journal of Family Medicine and Primary Care,4(3):384-387.
- 27.Jason J.et al.(2002).Clinical and Immune Impact of Mycobacterium bovis BCG Vaccination Scarring. Infection and Immunity,70(11),6188-6195.
- 28. Ertürk A, Çalışır H, Uğurman F, Balbay ÖA, Öğretensoy M.(2000). Atatürk Göğüs Hastalıkları ve Cerrahisi Merkezi Personelinde Tüberkülin Sensitivitesi ve Mikrofilm Çalışması, Solunum Hastalıkları, 11(1),60-9.
- 29.Ciesielski S D.(1995). BCG Vaccination and the PPD test: What the Clinician Needs to Know . The Journal of family practice,40:76-80.
- 30.Sugita M, Tsutsumi Y, Suchi M, Kasuga H, Ishiko T.(1990). Pulmonary tuberculosis. An Occupational Hazard for Pathologists and Pathology Technicians in Japan. Acta Pathologica Japonica, 40(2):116-127.
- 31.Bo M, Zotti C M.(2016) European Policies on Tuberculosis Prevention in Healthcare workers: Which role for BCG? A Systematic Review.Human Vaccines & Immunotherapeutics, 12:11, 2753-2764.
Öz
Tuberculosis (TB), continues to be one of today's public health problems with high morbidity and mortality rates despite global efforts. Healthcare professionals and students represent an important risk group for exposure and infection in both developing and developed countries. One of the important components of tuberculosis infection control is the routine screening of healthcare workers for latent tuberculosis infection and chemoprophylaxis for positive ones. The aim of this study is to analyze the distribution of purified protein derivative (PPD) reactions among healthy health technician students who will be active in the healthcare sector in the future and to determine the correlation between scar presence, scar number and PPD reactivity. The number of previous Bacillus Calmette-Guèrin (BCG) traces between the years 2017-2020 were evaluated retrospectively by demographic characteristics and PPD test. Statistical evaluations were made using the SPSS V.22 program. Independent variables are shown with numbers and percentages. Chi-square test was applied to dependent variables. A total of 390 students were included in the study. 13,1% of the students were found to be PPD positive. PPD positivity rates were determined as 10,0% (15-20 mm) and 3,1% (20 and above mm). The number of scars of the students varied from zero to two. The relationship between BCG scar numbers and PPD induration diameters were statistically significant (p<0,05). All of the students without BCG scar were PPD negative. The high rate of PPD negativity and BCG positivity among health technician candidates is an indicator of vaccine-induced protective immunity.
Anahtar Kelimeler
Proje Numarası
-
Kaynakça
- 1.World Health Organization.Global tuberculosis report 2019.Geneva:WHO;2019.https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1
- 2.Sağlık Bakanlığı Tüberküloz Tanı ve Tedavi Rehberi, 2. Baskı Ankara, Mayıs 2019 ISBN: 978-975-590-717-8.
- 3.Şi̇mşek A,Özkan S.(2019). Ankara İlinde Yapılan Aktif Sürveyans Uygulamasının Tüberküloz Hastalarının Kayıt ve Takibine Katkısının Değerlendirilmesi. Ankara Medical Journal, 19 ,71-82.
- 4. Xu Y, Schwartzman K.(2010). Referrals for Positive Tuberculin Tests in New Health care Workers and Sudents: A retrospective Cohort Study. BMC Public Health. 2010;10:28. Published 2010 Jan 20.
- 5.Centers for Disease Control and Prevention (CDC) .Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 2005, Morbidity and Mortality Weekly Report (MMWR) 54(RR17);1-141, (December 30, 2005).
- 6.Occupational Safety & Health Administration (OSHA). Occupational Exposure to Tuberculosis 1910.1035; Proposed Rule. OSHA Federal Register Final Rules 62:54159-54309, (1997, October 17). https://www.osha.gov/SLTC/etools/hospital/references.html
- 7.Bo M ,Zotti CM.(2016). European Policies on Tuberculosis Prevention in Healthcare Workers: Which Role for BCG? A Systematic Review.Human Vaccines & Immunotherapeutics, 12(11), 2753-2764.
- 8.Kinikar A, Chandanwale A, Kadam D, Joshi S, Basavaraj A.et al.(2019).High Risk for Latent Tuberculosis Infection Among Medical Residents and Nursing Students in India. PLOS ONE 14(7): e0219131.
- 9.Uden L, Barber E,Ford N, Cooke G S.(2017). Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis, Open Forum Infectious Diseases,4,(3),1-7.
- 10.Peters C, Kozak A, Nienhaus A, Schablon A.(2020). Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health,17(2):581,2-16. 11.Özkara Ş.(2000).Sağlık Çalışanları ve Tüberküloz. Flora,5(2),90-98.
- 12.Nayak S,Acharjya B.(2012). Mantoux Test and Its Interpretation. Indian Journal of Dermatology,3(1):2-6.
- 13.Pahal P, Sharma S.(2020). PPD Skin Test (Tuberculosis Skin Test) .In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
- 14.Hotta K, Ogura T, Nishii K, et al.(2007). Whole blood interferon-gamma assay for baseline tuberculosis screening among Japanese healthcare students. PLoS One,2(8),e803.
- 15.Xu Y, Schwartzman K.(2010). Referrals for Positive Tuberculin Tests in New Health care Workers and Students: A Retrospective Cohort Study. BMC Public Health,10(28),2-7.
- 16. Fjällbrant H. BCG Vaccination and the Tuberculin Skin Test in a Country with Low Prevalence of Tuberculosis: Epidemiological and Immunological Studies in Healthy Subjects. Sahlgrenska Academy University of Gothenburg Sweden 2008.
- 17.Ghaderi R .(2017). A New Formula for BCG Scar and Tuberculin Test Response,MOJ Immunol 5(5): 00171.
- 18. Bozkanat E, et al. (2016).Comparison of Tuberculin Skin Test and quantiferon-TB Gold in Tube Test for Diagnosis of Latent Tuberculosis Infection in Health care Workers: A Cross Sectional Study. Journal Of Pakistan Medical Association,66(3): 270-4.
- 19. Hizel K, Maral I, Karakuş R, Aktaş F.(2004). The influence of BCG immunisation on tuberculin Reactivity and Booster Effect in Adults in a Country with a High Prevalence of Tuberculosis. Clinical Microbiology and Infection, 10: 980-983.
- 20. İmre A, Arslan-Gülen T, Koçak M, Baş-Şarahman E, Kayabaş Ü.(2020). Sağlık Hizmeti Sunan Hastane Çalışanlarıyla Risk Grubunda Olmayan Sağlıklı Bireylerin Tüberkülin Deri Testi Sonuçlarının İrdelenmesi Klimik Dergisi,33(1),19-23.
- 21. Casas I, Esteve M, Guerola R, Latorre I, Villar-Hernández R, Mena G, et al. (2020) Serial testing of health care workers for tuberculosis infection: A prospective cohort study. PLoS ONE ,15(7), e0235986.
- 22. Uden L, Barber ., Ford N,Cooke G S. (2017). Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infectious Diseases, 4(3), 1–7.
- 23. Salehi M, Sharifi Mood B, Metanat M.(2016). Positive Tuberculin Skin Test Among Health Care Workers: Prevalence and Risk Factors in Teaching Hospitals of a Highly Endemic Region for Tuberculosis, Zahedan, Iran, Int J Infect. 2016 ; 3(3):e36158.
- 24. Chen B et al.(2019). Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities. International Journal of Infectious Diseases,79:26-33.
- 25. World Health Organization Informatıon sheet observed rate of vaccıne reactıons bacılle calmette-guérın (bcg) vaccıne.Geneva:WHO;2012 https://www.who.int/vaccine_safety/initiative/tools/BCG_Vaccine_rates_information_sheet.pdf?ua=1
- 26. Dhanawade SS, Kumbhar SG, Gore AD, Patil VN.(2015). Scar Formation and Tuberculin Conversion Following BCG Vaccination in Infants: A Prospective Cohort Study. Journal of Family Medicine and Primary Care,4(3):384-387.
- 27.Jason J.et al.(2002).Clinical and Immune Impact of Mycobacterium bovis BCG Vaccination Scarring. Infection and Immunity,70(11),6188-6195.
- 28. Ertürk A, Çalışır H, Uğurman F, Balbay ÖA, Öğretensoy M.(2000). Atatürk Göğüs Hastalıkları ve Cerrahisi Merkezi Personelinde Tüberkülin Sensitivitesi ve Mikrofilm Çalışması, Solunum Hastalıkları, 11(1),60-9.
- 29.Ciesielski S D.(1995). BCG Vaccination and the PPD test: What the Clinician Needs to Know . The Journal of family practice,40:76-80.
- 30.Sugita M, Tsutsumi Y, Suchi M, Kasuga H, Ishiko T.(1990). Pulmonary tuberculosis. An Occupational Hazard for Pathologists and Pathology Technicians in Japan. Acta Pathologica Japonica, 40(2):116-127.
- 31.Bo M, Zotti C M.(2016) European Policies on Tuberculosis Prevention in Healthcare workers: Which role for BCG? A Systematic Review.Human Vaccines & Immunotherapeutics, 12:11, 2753-2764.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 2 Ocak 2021 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 9 Sayı: 4 |
